Discoid Lupus Erythematosus (DLE)

Autoimmune Series:
Discoid Lupus Erythematosus (DLE)
Discoid Lupus Erythematosus (DLE) is the most common immunemediated skin disease that affects dogs.
DLE is the most
common
autoimmune
disease in dogs.
DLE is a member of the family of diseases of Lupus
Erythematosus (LE). However, DLE is the mildest form of LE
and typically involves the facial skin only (rarely it can involve
the feet & genitalia). Unlike systemic lupus erythematosus
(SLE) DLE does NOT cause other symptoms of illness (no
fever, lethargy, joint pain, etc.). The problem begins when
the dog develops antigen/antibody complex deposition and
the dermal-epidermal junction of the skin.
Collie with severe DLE
Symptoms are
aggravated by
sunlight.
Sun avoidance
& topical
therapies are
mainstay of
treatment.
Consult a
veterinary
dermatologist if
your dog is not
improving!
What is the cause of DLE?
The exact cause is not known. There does appear to be a genetic predisposition as
some breeds seem more commonly affected (Collies & Shelties, Australian shepherds,
Huskies are a few examples). Various explanations have been proposed for the cause of
DLE and include drug reactions, and viral initiation and UV light exposure. UV light
exposure is thought to be the most important and can exacerbate symptoms (even
causing seasonal worsening when the sun’s rays are strongest).
At what age does DLE typically develop?
Most often young adult dogs but it can occur in older dogs as well.
What do lesions look like? What are the symptoms of DLE?
DLE typically starts with depigmentation of the nose (planum nasale) and lips. The
normal “cobblestone” appearance of the nose is lost and can turn gray-pink in color.
The depigmentation then progresses to erosions and ulcerations. Lesions can
sometimes involve the skin around the eyes and the ears (pinnae). While these lesions
may be uncomfortable, your dog should otherwise feel fine.
Early Lesions of DLE
Later Lesions of DLE
Autoimmune Series:
Discoid Lupus Erythematosus (DLE)
How is DLE diagnosed?
DLE is the most
common
autoimmune
disease in dogs.
Skin biopsy! A skin biopsy is important because many other diseases can look like DLE.
Which lesions are take for skin biopsy and which pathologist interprets the skin
biopsies are very important. Veterinary dermatologists have specialized training to
help ensure an accurate diagnosis of this sometimes difficult to diagnose disease.
Ideally a pathologist with expertise in skin disease (“dermatopathologist”) should
interpret the biopsy.
How is DLE treated?
Symptoms are
aggravated by
sunlight.
Sun avoidance
& topical
therapies are
mainstay of
treatment.
•
The disease is aggravated by sunlight so restricting sun exposure during 10 am – 4
pm when UV rays are strongest is always recommended. Use of sunscreens/blocks
can be additionally helpful.
•
The goal of treatment is to control the disease and symptoms with the safest
medications at lowest possible doses to avoid negative side effects. Depending
on severity, more or less aggressive therapies may be recommended by your
veterinarian. Oral therapy with a combination of doxycycline & niacinamide; is
often used. This therapy can take up to 3 months for a maximum benefit so is
typically combined with topical medications (steroids and/or tacrolimus ointment).
Vitamin E & fatty acids can also be partially helpful.
•
In general, this disease is managed with conservative therapy prior to considering
therapy with long-term oral steroids or other chemotherapy drugs (such as
cyclosporine, azathioprine).
What is the prognosis?
Consult a
veterinary
dermatologist if
your dog is not
improving!
•
Good to excellent in most cases but lifelong treatment is often needed.
•
Periodic monitoring will be required to watch for any side effects depending on
the type of drug therapy that is being used.
•
If you are not seeing improvement within 3-4 weeks of initial diagnosis consider
having your pet see a veterinary dermatologist.
•
Veterinary dermatologists can be found through www.acvd.org